Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study

Squires, Patrick; Pahor, Marco; Manini, Todd M.; Vouri, Scott Martin; Brown, Joshua D.

doi:10.3390/jcm9092989

Cited by 8 publications

(7 citation statements)

References 20 publications

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“…Eight studies [14][15][16][17][18][19][20][21] met our criteria and were analysed to identify fall risk associated with ACB and to identify if the level of risk differs between ACB measures.…”

Section: Resultsmentioning

confidence: 99%

Anticholinergic burden measures and older people’s falls risk: a systematic prognostic review

Stewart

Taylor‐Rowan

Soiza

et al. 2021

Therapeutic Advances in Drug Safety

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Introduction: Several adverse outcomes have been associated with anticholinergic burden (ACB), and these risks increase with age. Several approaches to measuring this burden are available but, to date, no comparison of their prognostic abilities has been conducted. This PROSPERO-registered systematic review (CRD42019115918) compared the evidence behind ACB measures in relation to their ability to predict risk of falling in older people. Methods: Medline (OVID), EMBASE (OVID), CINAHL (EMBSCO) and PsycINFO (OVID) were searched using comprehensive search terms and a validated search filter for prognostic studies. Inclusion criteria included: participants aged 65 years and older, use of one or more ACB measure(s) as a prognostic factor, cohort or case-control in design, and reporting falls as an outcome. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results: Eight studies reporting temporal associations between ACB and falls were included. All studies were rated high risk of bias in ⩾1 QUIPS tool categories, with five rated high risk ⩾3 categories. All studies (274,647 participants) showed some degree of association between anticholinergic score and increased risk of falls. Findings were most significant with moderate to high levels of ACB. Most studies (6/8) utilised the anticholinergic cognitive burden scale. No studies directly compared two or more ACB measures and there was variation in how falls were measured for analysis. Conclusion: The evidence supports an association between moderate to high ACB and risk of falling in older people, but no conclusion can be made regarding which ACB scale offers best prognostic value in older people. Plain language summary A review of published studies to explore which anticholinergic burden scale is best at predicting the risk of falls in older people Introduction: One third of older people will experience a fall. Falls have many consequences including fractures, a loss of independence and being unable to enjoy life. Many things can increase the chances of having a fall. This includes some medications. One type of medication, known as anticholinergic medication, may increase the risk of falls. These medications are used to treat common health issues including depression and bladder problems. Anticholinergic burden is the term used to describe the total effects from taking these medications. Some people may use more than one of these medications. This would increase their anticholinergic burden. It is possible that reducing the use of these medications could reduce the risk of falls. We need to carry out studies to see if this is possible. To do this, we need to be able to measure anticholinergic burden. There are several scales available, but we do not know which is best. Methods: We wanted to answer: ‘Which anticholinergic scale is best at predicting the risk of falling in older people?’. We reviewed studies that could answer this. We did this in a systematic way to capture all published studies. We restricted the search in several ways. We only included studies relevant to our question. Results: We found eight studies. We learned that people who are moderate to high users of these medications (often people who will use more than one of these medications) had a higher risk of falling. It was less clear if people who have a lower burden (often people who only use one of these medications) had an increased risk of falling. The low number of studies prevented us from determining if one scale was better than another. Conclusion: These findings suggest that we should reduce use of these medications. This could reduce the number falls and improve the well-being of older people.

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Section: Resultsmentioning

confidence: 99%

Anticholinergic burden measures and older people’s falls risk: a systematic prognostic review

Stewart

Taylor‐Rowan

Soiza

et al. 2021

Therapeutic Advances in Drug Safety

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“…Zia et al 30 found that an ACB score ≥ 1 was associated with recurrent and injurious falls in older community-dwelling persons, but this association did not remain statistically significant after adjustment for gait and balance impairment. Squires et al 31 also examined the association between ACB scores and injurious falls in older community-dwelling persons and found that persons with a high ACB score had an increased risk for injurious falls over an average follow-up of 2.6 years. In contrast to our study, they only investigated falls resulting in a fracture or injury requiring hospitalization, while we also examined falls that did not result in injury.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, data on falls was collected by following patients for several months to years. 20 , 22 , 31 Following patients for a longer period of time increases the risk and amount of falling. Moreover, many patients in our study were exposed to anticholinergic drugs, but the median ADB score per patient was relatively low.…”

Section: Discussionmentioning

confidence: 99%

Anticholinergic Drug Use on Admission and the Risk of In-Hospital Falls in Older Hospitalized Patients

Akgün¹,

Oudshoorn²,

Mattace-Raso³

et al. 2022

CIA

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Purpose In-hospital falls, especially among older patients, are a major and underestimated problem. Several studies have suggested a possible association between anticholinergic drug use and falls, but the results are inconclusive and studies focusing on in-hospital falls are scarce. The aim of the present study was to investigate whether anticholinergic drug exposure on admission is associated with in-hospital falls. Patients and Methods This retrospective chart review study was conducted in the Erasmus MC University Medical Center, Rotterdam, the Netherlands. Patients aged 65 years and older, who were acutely admitted to the geriatric ward between 2012 and 2015, were included. Anticholinergic drug exposure was determined with the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden scale (ACB) and the list of Chew. Logistic regression was used to investigate the possible association between anticholinergic drug exposure and in-hospital falls. Analyses were adjusted for age, sex, fall history, fall as reason for admission, number of drugs on admission, use of a mobility aid and delirium. Results A total of 905 patients were included, of which 94 patients experienced one or more in-hospital falls. Each additional anticholinergic drug in use, according to the ARS, was associated with an increased odd of experiencing a fall (OR = 1.49, 95% CI: 1.06–2.10). Other measures, ie anticholinergic drug use (yes/no) and different categories of anticholinergic drug burden, measured with the ARS, ACB and list of Chew, were all not associated with in-hospital falls. Conclusion Anticholinergic drug exposure on admission is possibly not a main risk factor for in-hospital falls among older patients.

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“…Squire et al (Squires et al 2020) reported the presence of a strong association between those using medications with anticholinergic properties and mobility disability outcomes and injurious falls when compared to those not using these medications. Using the drug burden index, a study involving 602 residents of residential aged care facilities found a significant increased incidence in falls with over a 12-month period for those with low and high anticholinergic and sedative drug exposure (N.M. et al 2011).…”

Section: Discussionmentioning

confidence: 99%

A five-year prospective evaluation of anticholinergic cognitive burden and falls in the Malaysian elders longitudinal research (MELoR) study

Myint

Kioh

et al. 2022

Archives of Gerontology and Geriatrics

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Impact of Anticholinergic Medication Burden on Mobility and Falls in the Lifestyle Interventions for Elders (LIFE) Study

Cited by 8 publications

References 20 publications

Anticholinergic burden measures and older people’s falls risk: a systematic prognostic review

Anticholinergic burden measures and older people’s falls risk: a systematic prognostic review

Anticholinergic Drug Use on Admission and the Risk of In-Hospital Falls in Older Hospitalized Patients

A five-year prospective evaluation of anticholinergic cognitive burden and falls in the Malaysian elders longitudinal research (MELoR) study

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